Pain is Associated with Missed Clinic Visits Among HIV-Positive Women

Abstract

Background Pain is highly prevalent among HIV-positive individuals, with women representing a large subset of those with pain. However, little is known about the relationship between pain and retention in HIV medical care. Among a cohort of HIV-positive women of color, we evaluated the association between pain and retention in care, as measured by missed clinic visits. Methods The Health Resources and Services Administration’s Women of Color Initiative was a multi-site observational cohort study evaluating demonstration projects to engage HIV-positive women in medical care. From November 2010 to July 2013, 921 women were enrolled in the study across nine U.S. sites; baseline interviews collected data on socio-demographic, clinical, and risk behavior characteristics. Pain was assessed at baseline based on number of days in pain over the last 30 days and was categorized as no pain (0 days), infrequent pain (1–13 days), and frequent pain (14–30 days), with 14 days being the median. Missed visits over the one-year follow-up period, evaluated by chart abstraction, were dichotomized as ≤1 missed visit vs. >1 missed visit. We conducted multivariate logistic regression to assess the association between pain at baseline and missed visits, adjusting for pertinent covariates. Results Among our sample (N=862), 52.2% of women reported no pain, 23.7% reported infrequent pain and 24.1% reported frequent pain. Forty-five percent had >1 missed visit during the one-year follow-up period. Overall, we did not find a significant association between pain and missed visits (aOR 2.30; 95% CI 1.00–5.25). However, in planned stratified analyses, among women reporting current substance use at baseline, reporting frequent pain was associated with a higher odds of missed visits as compared with reporting no pain (aOR=15.14; 95% CI 1.78–128.88). Conclusion In our overall sample, pain was not significantly associated with missed visits. However, frequent pain was associated with missed visits among HIV-positive women of color who reported substance use at baseline. A better understanding of the relationship between pain and missed visits could guide efforts to improve retention in care in this population.

Psychosocial factors associated with persistent pain in people with HIV: a systematic review with meta-analysis

“… 39 , 110 The samples comprised predominantly men in 41 studies, with the proportion of men in these studies ranging from 51% 50 to 100%. 28 , 104 Five studies (4 from South Africa and 1 from the United States) recruited women exclusively 79 , 92 or predominantly (proportion of women ranging from 72% to 88%). 88 , 121 , 122 The mean age ranged from 30.1 (SD = 5.2) 114 , 115 to 51.0 (SD = 9.3) years.…”

“…Understanding the links between pain, ART adherence, and retention in care likely requires consideration of other psychosocial factors, such as substance abuse and depression, which may mediate or moderate this association. 68 , 92 …”

Impact of musculoskeletal symptoms on physical functioning and quality of life among treated people with HIV in high and low resource settings: A case study of the UK and Zambia

“…Not only are symptoms such as musculoskeletal pain associated with psychological distress, emotional problems, poor quality of life and suicidal ideation [10, 11], but they are also known to impact on activities of daily living [12] and are associated with higher rates of sick leave, loss of employment and lower satisfaction with health care [13]. Among PLWH, pain is also associated with poorer adherence to cART [14] and missed clinic visits [15].…”

Pain in people living with HIV and its association with healthcare resource use, well being and functional status

“…Not only is pain associated with psychological distress, emotional problems, poor quality-of-life and suicidal ideation [13][14][15][16][17], but it is also known to impact on activities of daily living [18] and is associated with higher rates of sick leave, job loss and lower satisfaction with health care [19]. Among PLWH, pain is associated with poorer adherence to ART [20,21], higher rates of viral load rebound [22], treatment switching [23,24] and, in some subgroups, missed clinic visits [25]. Furthermore, PLWH in pain are more likely to experience lack of social support [26] and to be involved in risky behaviours such as alcohol use, intravenous drug use and sexual risk taking [6,[27][28][29][30].…”